The long term goal of the Principal Investigator (PI) is to independently conduct a program of research on adherence with therapeutic regimens and quality of life of patients with cardiovascular disease. The goal of this 3-year training grant application is to develop research knowledge and skills needed to develop and test a multiple component model of medication treatment adherence, psychosocial moderators, and health-related quality of life in chronic illness. Examination of determinants of adherence through the use of models may provide a basis for developing intervention strategies to improve adherence and quality of life of patients with chronic illness. The specific aims of this proposal include: (1) to enhance the PI's research knowledge and skills in model building and model testing which include the study of theory development, structural equation modeling (SEM), as well as statistical methods and psychometric theory; (2) to augment the PI's knowledge and skills in the assessment and analysis of issues associated with medication adherence and quality of life through directed study as well as consultation with appropriate experts for application in the research process; and (3) to conduct research which will both advance the Pi's knowledge and skills as a researcher as well as explicate a model for examining adherence and quality of life in congestive heart failure (CHF). For Study l, the PI proposes to further analyze data from the Adherence in rheumatoid arthritis: Nursing Interventions, an RO1-NCNR study, PI Dr. Dunbar-Jacob. Data already obtained on 247 patients with rheumatoid arthritis (RA) will be analyzed for the purposes of model building and learning SEM. A multimeasure approach will be employed such that there will he two measures of each construct in the model. Study l results will be used to refine the measurement protocol. Study 2 proposes a pilot test of a measurement model that includes disease- specific measures with a sample of 50 patients with congestive heart failure (CHF). Study 3 proposes a survey of 200 patients with CHF. Data will be collected from medical record review, self-report questionnaires, and an electronic medication monitoring device. Hypotheses will be tested and causal relationships between medication adherence. quality of life, and a number of psychosocial variables in a CHF population will be examined using SEM. The model emerging from the CHF population will be compared to the RA adherence model. Sponsor, Dr. Dunbar-Jacob, will guide the PI in the proposed studies and research training. Cosponsor, Dr. Taylor, will guide the PI in SEM.